Billing code modifiers ensure payment for testing services
By Paula Hartman-Stein, Ph.D.
Remembering to add a new two digit number to a Medicare claim form impacts payment for psychologists conducting psychological testing as of Oct. 1.
If a clinician uses technicians or computers when conducting psychological or neuropsychological testing services, adding the number 59 after the procedure code on the claim form will make the difference as to whether a claim is paid under the federal Medicare system, according to Jim Georgoulakis, the APA representative to the Relative Update Committee of the American Medical Association.
"The two digit modifiers are here to stay and psychologists need to learn how to use them," he said.
The National Correct Coding Initiative (NCCI) determined the need for the new edits for technician and computer testing services. Regional Medicare carriers received the directive to require the edit in billing testing codes. According to Georgoulakis, if any changes in the edits occur in the future, those will be determined on a regional level by the fiscal intermediaries or insurance companies that have contracts with the Center for Medicare and Medicaid Services (CMS).
"Modifiers are not to be viewed as a penalty as some psychologists and professional groups see them," he said. "We cannot say we want to be treated like physicians for payment and then fight to be exempt from the same rules as our physician colleagues. Modifier 59, used with testing codes, for example, helps to clarify to the payer who provided the service."
When a psychologist conducts, interprets, and writes a neuropsychological evaluation on the same day that a technician performs face to face neuropsychological testing, or when the patient completes neuropsychological test using a computer, modifier 59 needs to be added to the claim.
Georgoulakis explained that the claim form in this example should include Current Procedural Terminology (CPT) codes 96118, 96119, and 96120 all followed with modifier 59, which identifies procedures or services that are distinct or independent of one another.
If the same clinician provides a neurobehavioral status exam (CPT 96116) and neuropsychological testing (CPT 96118) on the same date, modifier 59 is not needed, according to Georgoulakis.
Modifier 59 is also necessary when billing psychological testing codes 96101, 96102, and 96103 when those services are performed on the same date.
Another "edit" psychologists may need to use on occasion is modifier 52, signifying a reduced service, according to Georgoulakis. An example is when a patient cannot stay sufficiently alert to engage in psychotherapy due to a reaction from sedating medication, a scenario not uncommon in a nursing home or other in-patient setting.
If the therapist had planned a 20 to 30 minute psychotherapy session but because of the patientís reduced alertness level, the therapist stops the face to face session before 20 minutes, Georgoulakis advised coding such a session 90816 followed by modifier 52. The clinician will be paid for his/her time but at a reduced rate. In this case the therapist needs to document in the medical record the reason for the shortened session.
CMS developed the Correct Coding Initiative to promote methods of correct coding and to control improper coding leading to inappropriate payment in Part B Medicare claims. To learn more about edits check out the National Correct Coding Initiative (NCCI) at www.cms.hhs.gov/nationalcorrectcodInitEd/
"As psychologists are allowed to use more clinical procedure codes, modifiers will become increasingly important," said Georgoulakis. "I think the edits enable us to be more a part of the healthcare team."
Paula Hartman-Stein, Ph.D. is a geropsychologist, consultant, past president of the Society of Clinical Geropsychology and Chair of the Geriatric Behavioral Health Alliance of East Central Ohio. She can be reached through email, email@example.com or the website, www.centerforhealthyaging.com.
The National Psychologist, Vol. 15, No. 6, p 9.